Archive for June, 2013

While caffeine may seem like a harmless but necessary drug to get you through the day, the Wall Street Journal reports that it’s now the basis of two official diagnoses in the mental-health bible released in May, with a third under consideration. The most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, frequently called DSM-5, includes both caffeine intoxication and withdrawal. Both of these conditions are counted as mental disorders when they harm an individual’s ability to function in daily life.

Caffeine intoxication had been included in the previous version of the manual, known as DSM-IV, as a diagnosis. However, caffeine withdrawal was upgraded in DSM-5 from a “research diagnosis” to a diagnosis. Also, caffeine use disorder, which is when a person suffers disconcerting side effects and isn’t able to quit, was added to DSM-5 as a research diagnosis, meaning it needs more analysis to be included.

However, the new mental health diagnoses come with debate.

“Caffeine intoxication and withdrawal both occur fairly frequently but only rarely cause enough clinically significant impairment to be considered a mental disorder,” said Allen Frances, who chaired the task force that established the previous version of the DSM and has been an outspoken critic of the latest version. “We shouldn’t medicalize every aspect of life and turn everyone into a patient,” he added.

“The symptoms [of caffeine withdrawal] overlap with a lot of other disorders and medical problems,” said American University psychology professor Laura Juliano, who guided the DSM-5 Substance-Related Disorders Work Group. “We’ve heard many times people went to the doctor for chronic headaches or because they thought that they had the flu and it turns out it was caffeine withdrawal and they didn’t even know it.”

While caffeine is addictive, studies have shown that it is actually related to some health benefits. Nevertheless, various experts say that some individuals should avoid caffeinated goods, like those with anxiety, high blood pressure, insomnia, and diabetes.

In order to be diagnosed with caffeine withdrawal, a person has to experience at last three of five symptoms within 24 hours of stopping or decreasing caffeine intake: headache, fatigue or drowsiness, depressed mood or petulance, difficulty focusing, and flulike symptoms like nausea or muscle pain. Withdrawal symptoms often begin 12 hours after consumption and reach their peak at 24 hours.

For the majority of people, the symptoms will disappear in around a week and that may be preferable to spending a few weeks decreasing your caffeine intake only to find that the last step in quitting still leads to withdrawal symptoms.

Among routine caffeine drinkers who go without caffeine, headache is reported about 50% of the time and functional impairment about 13%, said Dr. Roland Griffiths, a professor at Johns Hopkins University School of Medicine in psychiatry and neuroscience who advised the DSM-5 work group.

Facing possible Medicare financial penalties has prompted hospitals to alter practices and habits that add to the hubbub. Some are changing the overhead pager system, others permitting patients to shut the doors to their rooms and hang a “Do Not Disturb” sign, while some are designating sleep hours which mean in some wings unless absolutely necessary, there’ll be no routine checks of vital signs. Other changes some hospitals are making include installing white-noise machines, sound-absorbing ceiling tiles and carpets in rooms and hallways, providing closed-circuit “relaxation programming” of calming music and pictures of nature, and “quiet kits” consisting of sleep masks and earplugs.

Studies show that hospital noise is more than just irritating; by disturbing patients’ sleep, it can actually stimulate increases in blood pressure, delay wound healing, and interfere with pain management.

Last year, after Medicare started basing part of hospital reimbursement on quality measurements like patient ratings on quality of care, hospitals really focused on increasing their noise-reduction efforts. The most recent figures from the federal program for the year ended in June 2012 and showed that just 60% of patients said the area outside of their rooms was quiet at night, the lowest satisfaction score given from the 27 questions about the hospital experience.

The Beryl Institute, a nonprofit that helps hospitals increase patient satisfaction, released a 2013 State of Patient Experience report in April that indicated hospital administrators ranked noise reduction as the most important priority for the second time since the last report conducted in 2011. Beryl mentioned changing behavior and culture as the biggest obstacles.

“There is a constant tension in hospitals between the need to create a place where patents can rest and heal and the realities of an active and almost chaotic work environment,” says Beryl president Jason Wolf. Noise can never be totally eliminated, he adds, but “we can counteract it.”
While many hospitals now have only private rooms, a factor that makes quietness more difficult is hospitals’ growing openness in their visiting hours and cellphone policies. Also, numerous hospitals are asking personnel to use “library” voice because soft whispers can be more soothing than normal speaking tones.

Many home health care aides are employed directly by people with disabilities or their families, as opposed to working for a private agency. The workers are by and large paid with Medicaid or Medicare funds managed by the state.

The Labor Department expects the number of home health-care workers to reach 3.2 million by 2020, a 68% increase from 1.9 million in 2010.
Home health-care workers are also known as personal-care aides, and their daily duties usually include bathing, dressing and feeding the elderly and those with disabilities, and they did this for a median wage of $9.70 per hour in 2010, according to the Labor Department’s reports. Many of these workers don’t have health-care coverage themselves.

Democratic lawmakers and unions agree that workers receiving public funds are state employees and therefore can be unionized. However, many Republican lawmakers and those anti-unionization argue that personal-care aides are independent contracts and therefore don’t qualify to join unions.

An estimated 25 percent of home care workers in America belong to unions. Perks vary for unionized home-care workers. The article noted that in northern California, personal-care aides who are members of SEIU make more than $12 per hour and a small number of them have health care through union contracts. However, in Michigan, SEIU organized 41,000 home-care workers in 2005, and today, many earn only $8 an hour, just slightly more than the federal minimum wage of $7.25 per hour. During the eight years of being a union member, those workers didn’t attain health benefits, sick leave, or vacation time.

The home health care industry expects a huge boom in coming years. Will your home health care agency have the working capital to meet the increased demand? If rapid growth impedes your cash flow, PRN Funding can help. Our home health care factoring services will keep your company operating effectively despite slow payment, HMOs, Medicare and other factors.

For years, physicians have been dictating their patient reports while medical transcriptionists have been trying to figure out what they’re saying. A recent article in For the Record discusses how technology such as electronic health records (EHRs) and speech recognition are turning these transcription challenges into serious downstream problems and what can be done to fix it.

Various habits and practices cause poor dictation, and even articulate dictators can sometimes fall victim to one or more of them. The propensity to multitask also can undermine the quality of the dictation. Physicians may eat or yawn while talking. They may be trying to speak on a speakerphone while driving in the car with the windows down. Oftentimes, dictation is done with others in the room so the medical transcriptionist must decipher one voice among four others in the background.

Unfortunately, the more physicians in a health system, the broader the range of poor dictation excuses. Melissa Campion, RHIA, CHDA, CHPS, CMT, an eHIM senior systems analyst for transcription at a big integrated health system in Melbourne, Florida, says that foreign accents, which many would assume to be an issue for transcriptionists, aren’t always a challenge. “The accents are actually easier to deal with because most of the doctors with a heavy accent are aware of it and try harder to make it clear,” Campion says, adding that her team has more difficult with dictation from physicians from the Deep South who may be oblivious of how their accents come through in the reports.

However, poor dictation isn’t really about accents, background noise, or speech patterns. Manager of transcription services at Lancaster General Health in Pennsylvania Kathy Lengel says communicating correct and complete data in an effective manner also can notably influence the quality and timeliness of the final report. “Poor dictators are very inconsistent in the format they use,” she states. “They don’t provide good patient information, and some of our poor dictators enter no patient demographic information. They jump all over the place. They have no rhyme or reason to how they’re dictating.”

The safety and quality of patient care are the main concerns when dictation challenges arise as they affect the timeliness and accuracy of the report. Treatment decisions are based on information in a patient’s chart so accuracy is of utmost importance as incorrect dosages could be disastrous or fatal. Many organizations refuse to fill something in if they aren’t 100 percent sure. The uncertainty impacts turnaround time and often requires reports being sent to the hospital to be manually fixed.

Being a good dictator takes several qualities, including being cognizant of the fact that someone on the other end has to be able to make sense of what you’re saying.

Medical transcription service organizations (MTSOs) may want to contemplate including contract language that tackles dictation problems. Medical transcriptionists are paid on a production basis, so having to struggle with poor dictation hampers their income potential. MTSOs may want to consider charging more if physicians are poor dictators and unwilling to improve the quality of communication.

Parallon, the Franklin, TN-based subsidiary of HCA Holdings Inc., will purchase The Outsource Group. Based in St. Louis, The Outsource Group is a healthcare revenue cycle management company that brought in $116 million in 2012 revenue.

Parallon employs over 22,000 workers and serves more than 1,400 hospitals and close to 11,000 non-acute care providers. The company works to improve the business performance of hospitals, health care systems and non-acute care providers. The new purchase enables Parallon to expand its outsourced business offerings to hospitals and health care practices and other related businesses.

Across the U.S., numerous states and cities have been recently passing bills that obligate employers to provide paid sick days, which have generated debate among employers and legislators, and have impelled some to overturn the laws.

In May, New York joined San Francisco, Washington D.C., and others as the latest city to pass this sort of bill. Under New York’s law, companies with 20 or more workers will have to provide five paid sick days starting in April 2014. Businesses with 15 or more employees have until October 2015 to obey.

Those who defend the bills say that mandatory paid sick leave is a public health issue that will help to deter the spreading of disease by letting employees who are sick or have a sick child stay home without having to worry about losing that day’s pay or their job. Other supporters see it as an issue of work-life balance that will allow workers to take care of their family.

However, some employers are against these laws because they’ll raise their businesses’ costs, which could prevent them from hiring new employees or potentially cause firings. Some claim that big employers already offer paid leave and forcing them to comply with new regulations just adds another burden.

The Center for Economic and Policy Research senior economist Eileen Appelbaum says that the average cost increase to most employers offering paid leave is a one-time rise of 2 percent in payroll costs. She claims that mandated paid leave levels the playing field, saying that “workers in low-paid jobs haven’t had access to paid leave and that’s tremendously unfair.”

The Family and Medical Leave Act, passed in 1993, promises up to 12 weeks of unpaid leave to covered workers. Appelbaum, who is the former director of the Rutgers University Center for Women and Work, says that higher-paid employees might be able to afford unpaid time off, but most employees can’t go without a paycheck for very long.

According to the BLS, while employers are not required by law to give paid sick leave, around 75% do.

With the Affordable Care Act (ACA) set to go into effect in January 2014, many employers supporting group health care plans are rushing to get ready for the impending changes. Here are some tips on how to prepare for the upcoming implementation of the ACA:

1. Figure out how the ACA will affect your business. According to Forbes, when the ACA is ratified, it will oblige businesses with over 50 full time workers to offer affordable healthcare to them. The ACA is demanding employer coverage just for those who work over 30 hours per week for a period of a month. Corporations who wish to avoid providing this medical insurance for their workers and who are on the verge of having 50 employees may then look to temps and staffing agencies in order to evade being forced to obey the law or create more part-time jobs as another way to shirk the ACA’s policies. Companies doing this will undermine the legislation and its intentions of increasing coverage to more American employees.

2. Choose whether to “pay” or “play” and make decisions about your insurance. To “pay” is to pay employer-shared-responsibility penalties of around $2,000 per employee per year. To “play” is to offer employer-sponsored coverage to fulltime employees.

3. Think about adding wellness program incentives. According to a recent survey by the Midwest Business Group on Health, more than 80% of the country’s biggest employers are looking to implement a penalty and reward system to encourage their workers to get healthy.

4. Organize and give out obligatory employee communications like a summary of benefits and coverage, plan descriptions, etc.

5. Amend your Health Insurance Portability and Accountability Act privacy and security rules and processes before the Sept. 23, 2013, deadline for acquiescence with final regulations.

6. Pay the first comparative effectiveness research fees by July 31, 2013, and plan for future reinsurance charges.

In a recent article in the nurses’ magazine Scrubs, a breakdown of nurses’ average pay per hour was conducted. Their article showed that while the Midwest boasts competitive pay rates for new nurses, the West Coast does have the highest pay per hour overall.

Nurse Zone reports that these are the average pay per hour numbers for top cities in the Midwest:

1. Home Health Aides. Expected to double by 2018, home health aides are projected to have the highest rate of growth. Though the pay for this job can be just above minimum wage, the availability of jobs and the fact that no college degree is needed have made this the job expected to be the highest in demand.

2. Medical Assistants. Another health career that doesn’t demand a college degree, medical assistant come second on the list with an estimated nearly 34% growth percentage from 2008-2018. Medical assistants help nurses and doctors with drawing blood, giving injections, taking a patient’s vital signs, and more. Though there are certification courses for medical assistants, most learn and are trained on the job.

3. Registered Nurses. Registered Nurses (RN) are supposed to have an increase in growth of approximately 22%. In the ten year period of 2008-2018, over half a million more RN jobs are supposed to be added. At the very least RNs need an associate’s degree, which is the most common level of education for RNs to have completed according to the BLS, though many also have a bachelor’s degree as well. Because of the higher levels of education RNs have, they’re paid more than medical assistants and home health aides.

4. Physicians and Surgeons. Expected to grow by 21.8% by 2018, roughly 144,000 jobs in these fields will be added. Physicians are already in such high demand today and experts estimate that as many as one of every ten physician openings remains unoccupied. Because of the high level of education required – a medical doctorate – to become a physician or surgeon, these jobs are among the highest paid in the healthcare realm.

5. Licensed Practical Nurse (LPN) & Licensed Vocational Nurse (LVN). Projected to have a 20.7% increase in growth by 2018, LPN and LVN jobs come in at number five on the list. LPN or LVN jobs don’t demand as much college as RN jobs so the pay is usually less for LPNs or LVNs but are above the pay grade and education levels of medical assistants.

6. Nursing Aides, Orderlies, Attendants. Nursing aides are supposed to see a projected 18.8% increase in growth from 2008-2018. While nursing aides and orderlies can be found in hospitals, typically they work in long term care or nursing homes.

If you are considering launching a medical staffing business, these fields may be your safest bet. Don’t forget – the higher the demand, the more cash flow you’ll need in hand. It’s a good thing PRN Funding is here and ready to fund your business with our medical staffing factoring programs. From nurse staffing to healthcare staffing programs – we work with staffing companies of all sizes to help them grow!

Recently, the U.S Department of Health and Human Services (HHS) has issued final rules applying some crucial consumer protections from the Affordable Care Act (ACA). The intention of lawmakers and government bureaucrats when drafting the Affordable Care Act legislation was to enrich health care benefits. Under the final rule, all individuals and employers will have the ability to buy health insurance coverage no matter what their health status may be.

Insurers will also be stopped from charging discriminatory rates to people and small employers based on reasons like health status or gender. The HHS is now demanding that most health plans include the following requirements by 2014:

1. Reasonable Health Insurance Premiums
Coverage offered to individuals by health insurance companies will only be allowed to vary their premiums based on age, tobacco use, family size, and geography; to base the premium on factors other than those will be illegal.

2. Availability
Almost all health insurers that offer coverage to individuals and employers will have to sell health insurance policies to all consumers; no one can be deprived of health insurance because of a current or past sickness.

3. Renewability
Under the new rules, health insurers will not be able to refuse to renew coverage due to a person becoming sick. Consumers hold the power to choose to renew coverage.

4. Single Risk Pool
Health insurance companies won’t be able to charge higher premiums to higher cost consumers by placing them into separate risk pools. The insurers will need to have a single statewide risk pool for the individual market and one for the small group market.

5. Catastrophic Plans
Consumers will have the right to a catastrophic plan in the individual market. The plan will typically have lower premiums, protection against high out-of-pocket costs, and include recommended preventive services without cost sharing.

When these ACA requirements go into effect in 2014, expect a substantial increase in patient volume. Whether you view healthcare reform as positive or negative, it could prove beneficial to nurse staffing and other forms of healthcare staffing.